Can Cachexia Lead to an Unavoidable Pressure Ulcer?
by Mary Ellen Posthauer RDN, CD, LD, FAND
Last month, I discussed the results of the NPUAP's 2014 "Unavoidable Pressure Injury: State of the Science and Consensus Outcomes" conference and their goal to establish a pressure ulcer registry for clinicians.
Nutrition plays a role in many of the diseases and conditions that impact the prevention and/or healing of pressure ulcers. Good nutrition reflects a healthy state and adequate body power. However, it is not always possible to sustain good nutritional status, in particular, when individuals are faced with a life threatening illness or exacerbation of a disease.
What Is Cachexia And Who Is At Risk?
Cachexia, a wasting syndrome with symptoms including unintentional weight loss, muscular atrophy and loss of apetite, is often the consequence of some diseases as a result of the length or severity of the illness. Cachexia is defined as cytokine-associated wasting of protein reserves and energy stores caused by the effect of diseases such as cardiac cachexia, end stage renal disease, COPD, cystic fibrosis, cancer, and rheumatoid arthritis. Cytokines – cell-mediated proteins produced by inflammatory cells – have been linked to anorexia, weight loss, cognitive dysfunction, anemia, and frailty. Cytokines directly cause feeding suppression and a lower intake of nutrients and is usually accompanied by anorexia. Nutritional support alone is inadequate in the management of cachexia and it is a major cause of malnutrition and increased mortality.
25-40% of individuals with COPD experience weight loss and those with an advanced disease state have reduced fat free body mass that is indicative of malnutrition. They experience elevated energy expenditure due to the increased work to breathe and reduce their dietary intake that tends to accelerate a negative nitrogen balance, especially during acute exacerbations of COPD. For many the question is "should I breathe or eat." Acute exacerbations of COPD are associated with a systemic inflammatory response that contributes to nutritional depletion and an increased risk for pressure ulcer development.
Cardiac cachexia is a complication of advanced congestive heart failure and again the classic features are weight loss and loss of lean body mass. It is interesting to note that the first description of cardiac cachexia was as early as 2300 years ago in 460 BCE in Greece. Older adults suffering from one or more of the diseases implicated frequently are those who experience cachexia and can be at increased risk for pressure ulcers. They are also a segment of the population that often tends not to consume an adequate diet thus placing them at increased risk for complications.
The NPUAP's Position On Cachexia And Unavoidable Pressure Ulcers
The consensus statement related to cachexia was "individuals with cachexia are at increased risk of developing an unavoidable pressure ulcer" and 100% of the organization representative voted yes and 91% of the audience. I view this statement as a call to action to become more cognizant and aware of the importance of the nutritional status of every individual for whom we are providing care.
There is no magic nutritional bullet that can cure or reverse cachexia. What we can do as clinicians is to work as a team and screen individuals early to determine their nutritional status. Intervene quickly before their condition deteriorates and provide clients practical suggestions for improving their nutrient intake, such as:
- Provide frequent small meals that always include protein
- Provide nutrient dense foods or supplements
- Explain importance of reducing salt intake
- Show how to read labels to detect sodium content
- Discuss the importance and type of exercise to maintain strength
If we are successful in strengthening the nutritional status of our clients, we can improve their quality of life and perhaps reduce the negative effects of cachexia.
About The Author
Mary Ellen Posthauer RDN, CD, LD, FAND is an award winning dietitian, consultant for MEP Healthcare Dietary Services, published author, and member of the Purdue University Hall of Fame, Department of Foods and Nutrition, having held positions on numerous boards and panels including the National Pressure Ulcer Advisory Panel and the American Dietetic Association's Unintentional Weight Loss work group.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.